美国-墨西哥边境地区急性心肌梗死住院率和冠状动脉介入治疗率的差异。

Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border.

机构信息

Howard University College of Medicine, Washington, DC 20060, USA.

出版信息

Am J Med. 2010 Jul;123(7):625-30. doi: 10.1016/j.amjmed.2010.01.018.

DOI:10.1016/j.amjmed.2010.01.018

PMID:20609685

Abstract

BACKGROUND

Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region.

METHODS

Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties.

RESULTS

Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery.

CONCLUSIONS

Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.

摘要

背景

急性心肌梗死的住院率可以深入了解弱势人群的医疗服务利用情况。然而，美国-墨西哥边境地区尚未报告这些数据。

方法

从亚利桑那州、加利福尼亚州和得克萨斯州的卫生部门获得了 2000 年的医院出院公共使用数据文件。急性心肌梗死的诊断基于国际疾病分类第 9 版临床修订版代码 410 作为主要出院诊断。此外，还列举了心脏导管插入术、经皮冠状动脉血管成形术和旁路移植术。出院病例被分为边境县和非边境县的医院发生的病例。

结果

总体而言，边境县有 12464 例医院出院病例将急性心肌梗死列为第一诊断。在边境县年龄为 45-64 岁和≥65 岁的人群中，得克萨斯州的出院率最低（例如，≥65 岁：得克萨斯州为每 10000 人 95 例，加利福尼亚州为 134 例），低于非边境县。在≥65 岁的人群中，得克萨斯州边境县的比率也低于非边境县，而在其他州则没有这种情况。相反，在得克萨斯州，导管插入术和旁路移植术的比率最高，而旁路移植术的比率实际上在边境县高于非边境县。在联合州的边境县和非边境县，西班牙裔的急性心肌梗死住院率低于非西班牙裔。在不同种族群体的边境县和非边境县，这一比率变化不大。经皮冠状动脉血管成形术和冠状动脉旁路手术的住院使用率也呈现出类似的模式。